Obstetric risk factors for umbilical cord prolapse: a nationwide population-based study in Japan
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To demonstrate the clinical course and the obstetric risk factors for umbilical cord prolapse.
The clinical course of reported cases of umbilical cord prolapse that occurred in Japan between 2007 and 2011 was retrospectively analyzed. The obstetric risk factors for umbilical cord prolapse were investigated by a nationwide population-based case-cohort study.
Three hundred and sixty-nine cases (0.018 %) of fore-lying/prolapsed umbilical cord in 2,037,460 deliveries were analyzed. Most cases of fore-lying umbilical cord were diagnosed by an ultrasound scan (78 %), whereas umbilical cord prolapse was most frequently diagnosed by an internal examination (63 %). Umbilical cord prolapse was found to be significantly associated with the following factors: multiple pregnancy [odds ratio (OR) 3.57; 95 % confidence interval (CI) 2.60, 4.90], non-vertex presentation (OR 4.67; 95 %CI 3.73, 5.86), preterm labor (OR 2.28; 95 %CI 1.83, 2.83), premature rupture of membranes (OR 3.84; 95 %CI 3.10, 4.77), prolapsed amniotic bag (OR 12.31; 95 %CI 9.00, 16.85), polyhydramnios (OR 2.89; 95 %CI 1.49, 5.61), and a birth weight of <2500 g (OR 2.26; 95 %CI 1.84, 2.79).
The current study is the largest in Japan to demonstrate the obstetric clinical course and risk factors associated with umbilical cord prolapse. Prolapsed amniotic bag, labor and rupture of membrane during premature period, and fetal abnormal presentation induced by multiple pregnancy, and polyhydramnios were high risk situation for umbilical cord prolapse.
KeywordsUmbilical cord prolapse Fore-lying cord Cord presentation Cervical balloon Emergency Cesarean section Fetal death Non-reassuring fetal status Fetal heart rate tracing Pregnancy complication
We are grateful to everyone who answered the present questionnaire survey, and who helped conduct and analyze the present study.
Hasegawa J., Sekizawa A. and Kinoshita K. designed the research. Hasegawa J., Sekizawa A., Ikeda T., Ishiwata I. and Kinoshita K. collected the data. Hasegawa J. and Sekizawa A. analyzed and interpreted the data, and drafted the manuscript. Hasegawa J. performed the statistical analyses.
The authors declare that they received no funding in association with the present study.
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest in association with the present study. The authors do not receive any financial support, nor do they own stock in any of the companies related to the present study.
This study was approved by the ethical board in the Japan Association of Obstetricians and Gynecologists. The present study was a retrospective analysis based on a questionnaire survey. Thus, the confidentiality of the patients involved was protected and no personal data was required for the present study.
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